Raw (unpasteurized) milk has been linked to many foodborne illnesses, including Campylobacter infections. In some states, including Colorado, it is legal to distribute unpasteurized milk through herdshare programs. Studies indicate that legalizing the sale of raw milk leads to more raw milk–associated outbreaks.

What is added by this report?

Although sale of raw milk is not legal in Colorado, herdshare programs, in which members may purchase a share of a herd of cows or goats, are legal and are not regulated by state or local authorities. During August–October 2016, 12 confirmed and five probable cases of Campylobacter jejuni infections were identified in persons who consumed raw milk from a herdshare dairy in Colorado. Pulsed-field gel electrophoresis identified the outbreak pattern in patients’ stools and two milk samples. Shareholders were notified about the outbreak, but the dairy was not ordered to close. This report highlights the public health challenges of addressing a high-risk product that is not regulated.

What are the implications for public health practice?

In states where distribution of raw milk from herdshares is legal, outbreaks associated with raw milk will likely continue to be a problem. The role of public health in implementing control measures associated with a product that is known to be unsafe should be further defined. State level guidelines might assist with this process.

February 01, 2018

Twenty-five babies were infected between 2006 and 2017 with the same strain of salmonella linked to a factory of dairy group Lactalis and that led to three dozen babies falling ill late last year, a French health research institute said on Thursday.

The Institut Pasteur, which is France’s reference center for monitoring salmonella, said the 25 cases were in addition to 38 cases in late 2017 and 141 in 2005 that were contaminated by “Salmonella Agona”, a bacteria found in baby milk produced by a Lactalis factory in northwest France.

The dairy company’s chief executive said in a newspaper interview on Thursday that Lactalis could have been producing salmonella-tainted baby milk since 2005, without confirming cases.

In France, surveillance of Salmonella infections is undertaken by the NRC and SPF. Between 2011 and 2016, Salmonella Agona accounted for 2.1% of Salmonella isolates identified in infants and received in the NRC, with between eight and 13 isolates received by the NRC a year. The detection of eight isolates of Salmonella Agona in infants within a period of 8 days alerted the NRC to the outbreak. No increase in the number of Salmonella Agona isolates was observed in other age groups. Prompt investigation provided strong epidemiological evidence pointing to infant milk products manufactured by the same company as the source of the outbreak.

This is the third outbreak of Salmonella associated with infant milk products reported in France. Similar outbreaks have also been reported elsewhere. A Salmonella Agona outbreak affecting 141 confirmed cases occurred in France in 2005 and was associated with two different products manufactured within the same facility implicated in the current outbreak. During the 2005 outbreak, samples of the implicated products and environmental samples from the facility yielded isolates with the same PFGE pattern as the clinical isolates. However, only one of 176 and four of 27 samples from the two implicated food products and six of 420 environmental samples tested positive for Salmonella Agona, suggesting a low level contamination.

The production dates of the positive food samples suggested a persistent environmental contamination. The source of the contamination in the facility was not identified. In the current outbreak, the environmental investigations are still ongoing, and at this stage no obvious source of contamination has been identified within the facility.

The number of cases associated with this outbreak is probably underestimated as cases with mild symptoms may not have consulted a healthcare professional or had comprehensive diagnostic investigations (stool sample, culture, identification of serotype, confirmation at the NRC). Despite this possibility, given the wide distribution of products and the small number of reported cases, the level of contamination of products is probably low.

The fact that the current outbreak involves the same serotype as the previous outbreak raises the question whether the organism has persisted in the facility for 12 years. The persistence of Salmonella Agona in a dry food production environment in the United States, resulting in two outbreaks 10 years apart, 1998 and 2008, has been reported before. Comparison of human and environmental isolates from 2005 with isolates from the current outbreak is ongoing to investigate this possibility.

December 31, 2017

SOWETO Market traders will from today not be allowed to conduct business at the premises until the cholera task force has cleaned and disinfected the area.

A Zambia National Information Services crew went round affected areas including Soweto market advising traders to stay away from the market today.

Earlier yesterday, a check by the Sunday Nation crew, found traders at Soweto Market going about their normal business.

However, the ZANIS crew with a public address system was moving around the market advising traders that they should not conduct any business from today until the market was cleaned.

Some of the traders spoken had mixed feelings over the Presidential directive to ban street vending.

Ms Margaret Mbewe, a widowed vegetable seller, was dismayed in that the business was her only source of income to support her children’s education.

She was however hopeful that banning street vending would only be a temporary measure to contain cholera and that thereafter, vendors would free to conduct their business.

“This is the only way we make money seeing that I am a widow we hope this is only a temporary measure to contain cholera and after the situation normalises we will be able to conduct business,” she said.

December 30, 2017

Zambian President Edgar Lungu has directed the military to help fight the spread of cholera, which has killed 41 people in the nation’s capital and made more than 1,500 others sick since late September.

The outbreak began on Sept. 28 but appeared to die down by Oct. 20, with fewer than five patients reported weekly until Nov. 5. The number of cases then surged, with 136 in the week beginning Nov. 26, the World Health Organization reported.

Presidential spokesman Amos Chanda said in a statement late on Friday that the president believed emergency measures were needed to contain the waterborne disease, including the closure of some markets.

The outbreak was initially confined to densely populated parts of Lusaka where poor sanitation can aid its transmission, but the disease had now spread to low density areas, Chanda said. “

The president is deeply concerned at rampaging advance of the epidemic and has therefore called on the defense forces to join other stakeholders ... and thoroughly clean up Lusaka,” Chanda said.

The outbreak was initially linked to contaminated water from shallow wells but investigations revealed that the spread was being propagated through contaminated food, he said.

“In the last two weeks, three traders from Soweto market have died from cholera and 18 are currently under admission in cholera treatment centers,” Chanda said, referring to Zambia’s largest market.

Chanda said all markets, bars, restaurants and other public places that pose a risk of further transmission of cholera would be closed until they met hygiene standards.

On 2 December 2017, an increase of cases infected with the Salmonella Agona strain was identified by health authorities in France in young children aged under six months. Subsequent investigations identified an outbreak of Salmonella enterica serovar Agona associated with infant formula products manufactured by the Lactalis Nutrition Santé group in France.

As of 21 December, 35 confirmed cases of Salmonella Agona infections among infants aged less than six months have been identified in different regions of France. Sixteen infants have been hospitalized but all have fully recovered and no deaths have been reported.

The outbreak was associated with consumption of four different brands of infant formula, including products designed for infants with special medical needs. On 10 December, Lactalis Nutrition Santé withdrew and recalled over 600 batches (more than 7000 tonnes) of implicated products that were manufactured from 15 February 2017 to present. The implicated infant formula products have been distributed internationally to more than 50 countries and territories.

On 21 December 2017, Lactalis Group has conducted a new recall including all infant and nutritional products manufactured or packaged in the Craon plant since 15 February 2017. Efforts to trace the distribution of products included in this expanded recall are underway and will be communicated to affected countries through INFOSAN as they are identified.

Public health response

French authorities ordered the suspension of marketing and exports and the recall of several infant formula products manufactured by the Lactalis Nutrition Santé group since 15 February 2017. On 9 December, health authorities issued three alerts to pharmacists and health facilities in France to stop delivering the products concerned.

November 22, 2017

The sugar industry funded animal research in the 1960s that looked into the effects of sugar consumption on cardiovascular health — and then buried the data when it suggested that sugar could be harmful, according to newly released historical documents.

The internal industry documents were uncovered by researchers at the University of California, San Francisco, and described in a new report in the journal PLOS Biology on Tuesday. The report’s authors say it builds on evidence that the sugar industry has long tried to mislead the public and protect its economic interests by suppressing worrisome research, a tactic used by the tobacco industry.

The documents show that in 1968 a trade group called the Sugar Research Foundation, known today as the Sugar Association, funded a research project on animals to shed light on the connection between sugar and heart health. But when the research pointed to a mechanism by which sugar might promote not only heart disease but also bladder cancer, the industry group ended the study and never published the results.

The sugar industry has long insisted that sugar has no unique role in promoting obesity, diabetes or heart disease, though numerous studies by independent researchers have concluded otherwise. Stanton Glantz, a professor of medicine at U.C.S.F. and an author of the new report, said that even though the newly discovered documents are 50 years old, they are important because they point to a decades-long strategy to downplay the potential health effects of sugar consumption.

“This is continuing to build the case that the sugar industry has a long history of manipulating science,” Dr. Glantz said.

The destruction left in Puerto Rico in the path of Hurricane María has pushed the condition of the island back several decades, including when the authorities work to assess the magnitude of the damage, a delegate of the territory has said.

"The devastation of Puerto Rico has put us back about 20-30 years. ... I can't deny that this is a different Puerto Rico from what we saw a week ago," said Jenniffer González, Resident Commissioner of Puerto Rico. "The devastation of property, the collapsed buildings, homeless families, ruins everywhere. The greenery of the island is gone," she added.

Engineers were planning on Sunday to inspect the 90-year-old Guajataca dam, whose reservoir covers 5 square kilometers (2 squar miles) in the northwest of Puerto Rico. The government has report the dam has an enormous crack since María dumped almost 15 inches of rain in the surrounding mountains. They pointed out that "it can collapse at any moment." Residents of the area were evacuated, but began to return to their homes on Sunday after a spillway was opened to relieve pressure on the dam.

Long after the mainland media have lost interest in the disaster, some of the worst consequences will emerge, and many of them will be in the public-health sector.

We can expect a spate of waterborne diseases: leptospirosis, skin infections, diarrhea, hepatitis A and E, typhoid, and maybe even cholera. Add to that untold swarms of mosquitoes, some carrying malaria, dengue, Zika, and chikungunya. As well, mental health issues will slow Puerto Rico's recovery as thousands struggle with PTSD, depression, and anxiety.

The healthcare system will struggle just to deal with such problems, never mind control or eliminate them.

So far, the US government has shown much more concern about uppity black millionaire athletes than about the fate of 3.5 million people living (barely) on American soil.

August 29, 2017

As health departments in Texas try to assist people with immediate medical needs following Hurricane Harvey, they're also looking to ensure those affected can get the prescription drugs they need and stay as safe as possible.

"Our best advice is always to avoid floodwater as much as you can," says Chris Van Deusen, a spokesman for the Texas Department of State Health Services. "Of course, people have had to be in the water — they haven't had a choice."

The state has already begun filling requests for tetanus vaccinations and is sending supplies of the vaccine to the affected areas. The Centers for Disease Control and Prevention recommends adults get a tetanus booster every 10 years; the bacteria can enter the body through breaks in the skin and can cause serious illness. The CDC also has specific recommendations for children on their website.

Van Deusen says water contamination from household chemicals and possibly industrial chemicals could be a problem, although as of midday Monday, he had yet to hear of a major industrial facility being flooded.

Dr. Phil Huang, medical director and health authority for Austin Public Health in the state capital, urges people to clean wounds with soap and water. "Certainly, there can be contamination with high levels of water — fecal contamination, things like that."

He also warns that well water could be contaminated as a result of flooding. He says it's important that people boil water for at least a minute before using it, or get bottled water.

Huang says in the days ahead, safety concerns could include carbon monoxide poisoning in households using generators; the consumption of contaminated food stored without refrigeration; and injuries suffered when people try to get back to their homes. Longer term, he says, mold will be an issue.

August 28, 2017

Fourteen people have died from an outbreak of hepatitis A in San Diego, and experts believe it to be the deadliest outbreak of the disease in the US in decades, the Guardian has learned.

In large part, the victims were homeless people who have had to contend with a lack of 24-hour public restrooms, even though hand-washing is one of the best defenses against infection.

The number of cases has exceeded other large outbreaks, said a Centers for Disease Control (CDC) spokesperson, and is “likely the most deaths in an outbreak in the US in the past 20 years”, the period in which the CDC has operated its electronic reporting system. In 2003, three people died and at least 124 were hospitalized after eating contaminated salsa at a Pennsylvania restaurant. In 2013, 69 people across 10 states were hospitalized after eating contaminated pomegranate seeds.

Yet in San Diego, 264 people have been hospitalized, roughly 70% of them homeless, in an outbreak that began last November, according to local health officials. Nine of the 14 deaths have occurred since mid-July.

The virus, which impairs liver function, causing jaundice, fatigue, joint pain and, in the most serious cases, death, is largely spread through food or water contaminated by fecal matter. Hepatitis A has a long incubation period – up to 28 days – which means people can spread the disease before they’re aware they’re infected.

A county spokesperson said epidemiologists have yet to determine the cause of the outbreak. Contaminated food is often the source of an outbreak, and Dr Rohit Loomba, director of hepatology at the University of California at San Diego, wondered if the source could have been food that groups distribute to homeless residents.

“My gut feeling is it was a common source where somebody might have given food to a group of homeless individuals,” he said. From there, the virus spread via personal contact. “They don’t have a clean water supply to wash their hands, and once they have hepatitis A, then they become a source for another person.”

Someone whose health is already compromised – by alcoholism, drug use or other illnesses – faces a higher risk of death from hepatitis A, Loomba said. He recommends that anyone who is homeless should get vaccinated.